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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Cash flows from operating activities      
Net income $ 49,932 $ 57,849 $ 45,741
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation and amortization 27,927 17,748 17,543
Amortization of debt issuance cost 1,828 1,061 939
Share-based compensation 34,536 22,040 16,101
Non-cash lease expense 5,278 7,183 3,759
Change in fair value of contingent consideration liabilities 3,526 0 0
Gain on debt extinguishment (2,398) 0 0
Unrealized (gain) loss on investments (731) 4,782 25,506
Income from equity method investments, net (4,451) (5,579) (5,622)
Unrealized gain on interest rate swaps 0 (201) (4,235)
Gain on sale or distribution of investments 0 (1,246) (2,272)
Deferred tax (4,249) (12,444) (14,278)
Loss on consolidation of equity method investment 0 0 901
Impairment of beneficial interest   422 0
Other 4,613    
Changes in operating assets and liabilities, net of acquisition amounts:      
Receivable, net (44,388) (26,735) (38,194)
Receivable, net – related parties 8,623 6,167 4,229
Other receivable 24,670 311 8,196
Prepaid expenses and other current assets (10,854) (2,956) 818
Other assets (8,875) 2,864 (243)
Accounts payable and accrued expenses (30,919) (170) (49)
Fiduciary accounts payable 487 (328) (2,470)
Medical liabilities 10,570 18,610 22,786
Income taxes payable/receivable (8,622) (14,477) 6,917
Operating lease liabilities (4,825) (6,674) (3,945)
Other liabilities 520 0 0
Net cash provided by operating activities 52,198 68,227 82,128
Cash flows from investing activities      
Payments for business and asset acquisition, net of cash acquired (146,260) (6,512) (16,352)
Proceeds from repayment of promissory notes, including those with related parties 256 2,676 4,067
Purchases of marketable securities (109) (2,151) (1,854)
Proceeds from sale of marketable securities 124 491 31,671
Issuance of promissory notes (26,000) (26,473) 0
Purchases of property and equipment (8,031) (28,529) (22,940)
Purchases of investments –privately held (2,500) (4,000) 0
Purchases of investments – equity method (5,968) (325) 0
Purchase of call option issued in conjunction with equity method investment (3,907) 0 0
Distribution from investment - equity method 0 0 400
Contribution to investment - equity method 0 (700) (2,105)
Net cash used in investing activities (192,395) (65,523) (7,113)
Cash flows from financing activities      
Dividends paid (4,036) (62,074) (14,030)
Repayments on long-term debt (18,500) (204,681) (3,865)
Borrowings on long-term debt 171,875 284,527 3,598
Payment of finance lease obligations (670) (675) (561)
Proceeds from exercise of stock options and warrants 755 1,522 8,633
Proceeds from ESPP purchases 271 0 0
Taxes paid from net share settlement of restricted stock (4,662) 0 0
Repurchase of treasury shares (937) (10,192) (9,250)
Purchase of non-controlling interest (40) (78) (5,046)
Proceeds from sale of noncontrolling interest 150 0 436
Cost of debt issuances 0 (3,928) 0
Payment of financing obligation (8,542) 0 0
Payment of contingent consideration liabilities (518) (1,000) 0
Net cash provided by (used in) financing activities 135,146 3,421 (20,085)
Net (decrease) increase in cash, cash equivalents, and restricted cash (5,051) 6,125 54,930
Cash, cash equivalents, and restricted cash, beginning of year 294,152 288,027 233,097
Cash, cash equivalents and restricted cash, end of year 289,101 294,152 288,027
Supplemental disclosures of cash flow information      
Cash paid for taxes 43,936 56,567 47,311
Cash paid for interest 30,419 14,251 6,672
Supplemental disclosures of non-cash investing and financing activities      
Right-of-use assets obtained in exchange for operating lease liabilities 14,117 25,124 0
Common stock issued in business combination 21,952 800 1,000
Common stock issued for contingent consideration payment 4,023 0 0
Acquisition of business through loan conversion 5,175 0 0
Draw on letter of credit through Revolver Loan 4,732 0 0
Tax impact from APC dividends to APC Shareholders 0 3,076 0
Distribution of real estate investments 0 152,767 0
Mortgage loan 0 0 16,275
Reconciliation of cash, cash equivalents, and restricted cash      
Cash and cash equivalents 288,455 293,807 288,027
Restricted cash 646 345 0
Total cash, cash equivalents, and restricted cash shown in the statement of cash flows $ 289,101 $ 294,152 $ 288,027

Source

10-K PDF
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